# BLUE HERON NEUROFEEDBACK AND COUNSELING

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669039178
- **Authorized official:** STACIE L LECLERC LCMHC, MLADC (OWNER)
- **Authorized official phone:** (603) 356-6400

## Contact information

- **Practice address:** 379 WHITE MOUNTAIN HWY, CONWAY, NH 03818-4206
- **Practice address phone:** (603) 356-6400
- **Practice address fax:** (603) 413-4666
- **Mailing address:** 111 SARANAC ST STE 140, LITTLETON, NH 03561-4089
- **Mailing address phone:** (603) 356-6400
- **Mailing address fax:** (603) 413-4666

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | — | NULL | — |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | — |
| 106H00000X | Marriage & Family Therapist | — | — | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |
| 261QR0405X | Substance Use Disorder Rehabilitation Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 05/21/2019
- **Last updated:** 11/11/2025